| NPI | 1508042235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY MAX BOWEN Member 304-587-7495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV WV3570) |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2008-01-11 |